The TRICARE Pharmacy Program and Compounded Medications – Update: TRICARE to Delay Implementation for 180 Days
Jul 02 2013
UPDATED August 1, 2013:
Based upon massive beneficiary input, TRICARE is evaluating the issue of pharmaceutical compounds. They are continuing work to ensure both excellent and safe care for all beneficiaries and clear communication with both providers and beneficiaries. To assure success in both of these efforts, TRICARE will delay the implementation of any change in practice on compounded prescriptions for 180 days.
Compounded prescriptions are tailored for individuals by pharmacists. These prescriptions may contain both conventional medications and other ingredients. Many of the included ingredients are not FDA approved.
Those compound prescriptions which contain ingredients that are not FDA approved are the ones that TRICARE is concerned about.
Recently, over 44,000 TRICARE beneficiaries received a notification letter from Express Scripts, informing them that based upon their medication history they are currently, or have recently, used a medication which contains a bulk chemical or bulk powder. These types of ingredients are most commonly used in what is termed “compound medications” and they will no longer be covered as of the 24th of July.
Pharmacy compounding is a practice in which a licensed pharmacist combines, mixes, or alters ingredients of a drug in response to a prescription to create a medication tailored to an individual’s particular needs. These are usually not readily available nor approved by the Food and Drug Administration (FDA). This is where the rub is.
For the safety of beneficiaries, when a compound prescription has an ingredient that isn’t FDA approved, TRICARE by law cannot cover the prescription. This has always been the case, and due to the implementation of new screening software, prescriptions containing these types of ingredients can now be readily identified.
Who typically needs compounded medications?
- Babies and children, especially preemies, who need medications in extremely small doses, and often need them to treat certain gastro-esophageal diseases.
- Children, who might need something that is more palatable (fruity flavors can be added).
- People with allergies to commercial drugs, which often contain lactose.
- Many elderly and others who need medication in a different form – for example, a liquid because they have trouble swallowing.
TRICARE Pharmacy provides coverage for a wide range of FDA approved medications. Many of the bulk chemicals and powders are not FDA approved and thus not covered under the benefit.
If you are still using a FDA non-approved medication it is recommended that you talk with your provider to see if there is an appropriate alternative which is covered.
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